Significance of different response evaluation criteria in predicting progression‐free survival of lung cancer with certain imaging characteristics

Abstract

BackgroundCertain radiographic signs of a treatment response, such as cavitation, changes in density, or tumor change along a short axis, are not considered by Response Evaluation Criteria in Solid Tumors (RECIST). This study evaluates what additional prognostic information can be obtained by including these criteria in tumor assessment.MethodsData of 105 patients were included. Tumor cavitation was observed in 51 patients at baseline. An additional 23 patients developed tumor cavitation during treatment. A change in tumor density was the only radiographic treatment response observed in 22 patients. The only measureable treatment response in nine patients was a decrease along the short axis size of the tumor. Tumor response was assessed using various criteria.ResultsIn patients with basic tumor cavitation, RECIST1.1 scores accurately predicted differences in progression‐free survival (PFS; P = 0.076) while modified (m) RECIST did not (P = 0.550). mRECIST detected a significant difference between PFS in patients with post‐therapeutic cavitation with different responses, but no significant difference using RECIST1.1 (P = 0.004 vs. P = 0.477). In patients with only tumor density changes, there was no significant difference in PFS when either RECIST1.1 or density criteria were used (P = 0.419). In patients with a change in size along the tumor's short axis, short axis criteria could predict significant difference in PFS (P = 0.004).Conclusions RECIST1.1 provides the best assessment of tumor response and prediction of PFS in patients with basic tumor cavitation. mRECIST provides better PFS prognostic information in patients with post‐therapeutic cavitation. Short axis criteria provides better PFS prognostic information in patients with changes in the short axis of tumor diameter. Changes in tumor density were not a useful prognostic sign.

Diffusion-Weighted Magnetic Resonance Imaging for Early Detection of Chemotherapy Resistance in Non-Small Cell Lung Cancer

“…Clinically, CT images are used for the assessment of the efficacy firstly after the end of 2 cycles of chemotherapy [4]. The treatment would be continued for the effective and stable cases according to the original chemotherapy protocol, and reassessment is performed every 2 cycles thereafter [4–6]. Normally at least 4 cycles of chemotherapy would be administrated before drug resistance was determined, largely delaying the timing of treatment and wasting medical resources, as well as increasing the economic burden of patients [4].…”

“…Therefore, early detection of chemotherapy-resistance can guide the adjustment of clinical treatment programs in a timely manner, significantly improving the patient’s prognosis. At present, the evaluation of treatment efficacy and drug resistance of chemotherapy in lung cancer generally conforms to the Response Evaluation Criteria in Solid Tumors (RECIST1.1) [4–6], which evaluates the changes in the maximum diameter of target lesions on computed tomography (CT). However, due to the late occurrence of morphological changes in tumors, at least 4 cycles of chemotherapy would typically be used before drug resistance would be determined, delaying the timing of treatment and wasting medical resources [4].…”

Circulating tumor cells criteria (CyCAR) versus standard RECIST criteria for treatment response assessment in metastatic colorectal cancer patients

“…RECIST has been adopted as the standard method for tumor assessment and helps in clinical decision making. Deciding and then monitoring the effectiveness of individual therapies in mCRC patients is currently very challenging, as a result of the high prevalence of lymph abdominal, peritoneal, serous and pleural metastasis, which are particularly difficult to evaluate by RECIST [ 16 ]. In addition, the thresholds (of response or progression) for predicting differences in survival in treated patients probably differ according to the type of treatment and the type of cancer [ 17 ].…”

The Value of CBCT-based Tumor Density and Volume Variations in Prediction of Early Response to Chemoradiation Therapy in Advanced NSCLC

“…and Mayer et al . proposed a reliable quantitative method to assess tumor response and predict clinical outcomes 9 , 10 . Previous studies have correlated the variation in the CT number (CTN) with radiation-induced pulmonary toxicity 11 and breast cancer metastasis to axillary lymph nodes 12 .…”